Brain Metastases

The incidence of brain metastases is higher in patients who have adenocarcinoma of the lung than in other histologic types of lung cancer. Untreated brain metastases have a mean survival of only a month and this is doubled if the patient is treated with steroids alone and improved to 4 months with cranial radiation. There are some instances that a solitary lesion in the brain may be resectable if there are no other contraindications. Therefore, in patients with nonsmall cell lung cancer who have good prognosis based on the management of their primary cancer, a solitary brain metastasis presenting simultaneously or after lung resection should be surgically excised. The role of postoperative radiation therapy to the brain is unclear at this point.

Other than solitary brain metastases, the presence of extrathoracic metastatic lesions for nonsmall cell lung carcinoma precludes resection of the primary tumor.